From the Department of Plastic and Reconstructive Surgery, Osaka City General Hospital.
Yanaga Clinic and Tissue Culture Laboratory.
Plast Reconstr Surg. 2023 Feb 1;151(2):282e-287e. doi: 10.1097/PRS.0000000000009854. Epub 2022 Nov 10.
Microtia repair requires a large volume of reconstruction material.In pediatric patients, the collectable volume of autologous cartilage is limited, and the impact of surgical invasion and donor-site morbidity can be particularly severe. The authors developed a new treatment method using cultured autologous human auricular chondrocytes that provides a sufficiently large volume of reconstruction material.
Approximately 1 cm2 of auricular cartilage was collected from the affected site. Chondrocytes were isolated and cultured with autologous serum to accelerate cell proliferation. The cells were subcultured and formed a gel-form mass without a scaffold. In our two-stage implantation, the cultured chondrocytes were first injected into the patient's lower abdomen, where the cells grew into a large, newly generated cartilage in 6 months. Thereafter, this cartilage was sculpted into an ear framework and subcutaneously reimplanted into the new ear location. Clinical outcomes were assessed over a long-term follow-up.
Eight patients underwent surgery using cultured autologous auricular chondrocytes from 2002 to 2008. The patients' ages ranged from 6 to 10 years. The follow-up period ranged from 11 to 18 years. None of the patients experienced absorption of cultured chondrocytes after the second stage. Complications included one case of absorption and one case of allergic reaction in the first stage.
The authors' patients represent the first successful cases of regenerative surgery for microtia using cultured chondrocytes. No malignant transformation, change in size, deformation, or other abnormalities were observed during the long-term follow-up, demonstrating the safety of cultured cartilage. No major complications occurred.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
小耳畸形修复需要大量的重建材料。在儿科患者中，自体软骨的可采集量有限，手术侵袭和供体部位发病率的影响可能特别严重。作者开发了一种新的治疗方法，使用培养的自体人耳软骨细胞，提供足够大的重建材料体积。
从受影响部位采集约 1cm2 的耳软骨。分离软骨细胞并与自体血清培养以加速细胞增殖。将细胞传代培养并形成无支架的凝胶状块状物。在我们的两阶段植入中，首先将培养的软骨细胞注射到患者的下腹部，在那里细胞在 6 个月内生长成大的新生成软骨。此后，将该软骨雕刻成耳框架并皮下重新植入新的耳部位置。通过长期随访评估临床结果。
2002 年至 2008 年期间，有 8 名患者接受了使用培养的自体耳软骨细胞的手术。患者年龄 6 至 10 岁。随访时间为 11 至 18 年。第二阶段后没有患者出现培养软骨细胞吸收。并发症包括第一阶段吸收和过敏反应各一例。
作者的患者代表了使用培养软骨细胞进行小耳畸形再生手术的首例成功病例。在长期随访中，未观察到恶性转化、大小变化、变形或其他异常，表明培养软骨的安全性。未发生重大并发症。
临床问题/证据水平：治疗，IV。
